1. Abdomen
History & Examination

2. Important history
 Dyspepsia- heartburn
 Dysphagia- difficulty swallowing
 Altered bowel habit- diarrhea/constipation
 Pain- colicky, stretch, radiation, referred
 Bleeding- UGI/LGI
 Jaundice
 Urinary symptoms- hematuria, dysuria, frequency,
urgency, hesitancy, retention
 Appetite
 Dietary history

3. Examination
 Oral cavity
 Abdomen
 Male genitalia
 Anus/rectum

4. Oral cavity
 Angular stomatitis, cheilitis
 Teeth- number, color, ridges, caries
 Gums- swelling, bleeding, pyorrhea
 Buccal mucosa- ulcer, pigmentation
 Tongue- size, color, papillae
 Palate, tonsils, pharynx

5. Abdomen- regions
 4-
vertical & horizontal planes thru umbilicus-
RUQ, RLQ, LUQ, LLQ
 9-
vertical planes thru 9th
costal cartilage & femoral
artery; horizontal planes are subcostal &
interiliac- R & L
hypochondrium, lumbar, iliac and
epigastrium, umbilical, hypogastrium

6. Abdomen- regions

7. Quadrants & organs
 RUQ- liver, GB, upper pole of R kidney,
hepatic flexure of colon
 LUQ- stomach, spleen, pancreas, upper
pole of L kidney, splenic flexure of colon
 RLQ- lower pole of R kidney, appendix,
terminal ileum, R colon, R ovary
 LLQ- lower pole L kidney, L colon,
L ovary

8. Pre-examination
 Comfortable room & couch
 Adequate light
 Patient lying supine
 Adequate exposure
 Examiner’s hand at the level of patient’s
abdomen

9. Examination- components
 Inspection- see, don’t touch
 Palpation- touch
 Percussion- tap
 Auscultation- use stethoscope

10. Inspection
 Shape- scaphoid, normal, distended
 Umbilicus- shape, inverted/everted
 Movements- normal or restricted,
pulsation, visible peristalsis
 Striae or scars
 Prominent veins
 Genitalia & groin

11. Palpation
 Relaxed patient & abdominal wall
 Start from the point farthest from
possible area of involvement
e.g. for liver start from LLQ
& for spleen from RLQ
 Palpate whole abdomen in an order

12. Special techniques
 Deep palpation- in obese, muscular or
poorly relaxed
 Dipping- tense ascites
 Bimanual- for kidney & spleen
 Ballotable- kidney
 Shifting dullness & fluid thrill- for ascitis

13. It helps
 Spleen
 L hypochondrium
 Grows towards RLQ
 Upper border not
reached
 Moves with respiration
 Medial notch
 Not ballotable
 Dull on percussion
 L kidney
 Renal angle posteriorly
 Grows towards LLQ
 Upper border reachable
 Restricted mobility
 No notch
 Ballotable
 Colon overlying on
percussion

14. Liver
 RUQ
 Moves with respiration
 Tender or not?
 Edge- soft, firm, hard
 Surface- smooth, nodular
 Pulsatile in TR
 Confirm span by percussion

15. Gall bladder
 Underlies liver in RUQ
 Moves with respiration
 Usually not palpable
 Tender- Murphy’s sign- +ve in acute
cholecystitis
 Palpable GB- mucocoele, cancer,
CBD obstruction

16. Urinary bladder
 Midline, suprapubic
 Usually not palpable
 When palpable- smooth, symmetrical,
lower border not reached,
 Urge to micturate on palpation
 Dull on percussion

17. Percussion
 Only light percussion required
 Resonant note allover, except over liver
where it is dull
 Used to confirm liver or spleen or
bladder enlargement & ascitis

18. Auscultation
 Paraumbilical
 For bowel sounds or bruit
 Normal BS- intermittent gurgles
interspersed with tinkles
 Increased- intestinal obstruction
 Decreased- paralytic ileus
 Bruit- over aorta, iliac/renal arteries

19. Don’t forget
 Groin- LNE, hernia
 Male genitalia
 PR examination- for local pathology,
prostate examination in males

20. Stigmata of CLD
 Muscle wasting
 Pallor, jaundice
 Clubbing
 Palmar erythema
 Dupuytren’s contracture
 Spider nevi
 Gynecomastia
 Testicular atrophy
 Caput medusae
 Ascites

21. Supported by
X-ray, US/CT, Endoscopy